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Diabetes Care Sep 1994To increase awareness of adverse events associated with the use of programmable implantable pumps (PIPs).
OBJECTIVE
To increase awareness of adverse events associated with the use of programmable implantable pumps (PIPs).
CASES
There were 7 cases of complications associated with the pump-pocket among 40 patients treated by PIP, and we searched for risk factors.
RESULTS
Seven of 40 type I diabetic patients treated by PIP presented severe complications of the pump-pocket, resulting in five definitive explanations and nine other surgical interventions. The lesions included an exudative reaction in the pump-pocket and a skin retraction or atrophy, which were complicated by skin erosion in five patients. Coagulase-negative staphylococcus was identified in the pump-pocket in four patients, including three cases of skin erosion. No specific risk of local complications could be attributed to age, sex, duration of diabetes, body mass index, presence of retinopathy or peripheral neuropathy, HbA1c level since implantation, depth of implantation in the abdominal wall, or duration of experience with PIP. Usual physical activity corresponding to > 2,000 kcal energy expenditure per week, estimated by a questionnaire, appeared to be the only identified significant risk factor.
CONCLUSIONS
From these results, we suggest that physical activity should be limited to moderate exercise and exclude vigorous efforts in diabetic patients treated by PIP to avoid an increased risk of complications at the implantation site.
Topics: Adolescent; Adult; Aged; Atrophy; Diabetes Mellitus, Type 1; Exercise; Female; Humans; Incidence; Infusion Pumps, Implantable; Insulin Infusion Systems; Male; Middle Aged; Risk Factors; Skin Diseases
PubMed: 7988309
DOI: 10.2337/diacare.17.9.1064 -
Health and Human Rights Dec 2019Through focusing on the neoliberal "Health Transformation Programme" launched in 2003 in Turkey, I show how reproductive law can be modified by neoliberal mechanisms...
Through focusing on the neoliberal "Health Transformation Programme" launched in 2003 in Turkey, I show how reproductive law can be modified by neoliberal mechanisms that are implemented with neoconservative policies and pressures. The paper builds on original data collected in 2014 and 2015 through focus groups and interviews with health practitioners in family health centers and women receiving reproductive care in Izmir, Diyarbakir, Van, and Gaziantep. The data analysis informed by writings on the debt economy by Maurizio Lazzarato and Bifo Berardi and transnational feminist theory demonstrate that neoliberal mechanisms of "dismantling the public" interact with pronatalist policies and pressures to erode women's reproductive rights in Turkey. This has resulted in (1) indebtedness of women through out-of-pocket payments for contraception and abortion, (2) indebtedness of providers through performance measures, (3) reduction in the quality of reproductive care, and (4) reduction in access to reproductive care itself (contraception, counseling, and abortion). There is a need to pay attention to neoliberal mechanisms and the legal framings of reproductive rights to fully understand the limitations of law and counter the neoliberal and conservative assaults on women's sexual and reproductive rights.
Topics: Abortion, Induced; Adult; Contraception; Female; Focus Groups; Health Expenditures; Health Services Accessibility; Health Surveys; Humans; Interviews as Topic; Politics; Pregnancy; Reproductive Rights; Turkey; Women's Rights
PubMed: 31885436
DOI: No ID Found -
HeartRhythm Case Reports Nov 2023
PubMed: 38023679
DOI: 10.1016/j.hrcr.2023.08.010 -
Journal of Personalized Medicine Apr 2021Intravenous ports serve as vascular access and are indispensable in cancer treatment. Most studies are not based on a systematic and standardized approach. Hence, the...
Intravenous ports serve as vascular access and are indispensable in cancer treatment. Most studies are not based on a systematic and standardized approach. Hence, the aim of this study was to demonstrate long-term results of port implantation following a standard algorithm. A total of 2950 patients who underwent intravenous port implantation between March 2012 and December 2018 were included. Data of patients managed following a standard algorithm were analyzed for safety and long-term outcomes. The cephalic vein was the predominant choice of entry vessel. In female patients, wire assistance without use of puncture sheath was less likely and echo-guided puncture via internal jugular vein (IJV) with use of puncture sheath was more likely to be performed, compared to male patients ( < 0.0001). The procedure-related complication rate was 0.07%, and no pneumothorax, hematoma, catheter kinking, catheter fracture, or pocket erosion was reported. Catheter implantations by echo-guided puncture via IJV notably declined from 4.67% to 0.99% ( = 0.027). Mean operative time gradually declined from 37.88 min in 2012 to 23.20 min in 2018. The proposed standard algorithm for port implantation reduced the need for IJV echo-guided approach and eliminated procedure-related catastrophic complications. In addition, it shortened operative time and demonstrated good functional results.
PubMed: 33923312
DOI: 10.3390/jpm11050344 -
Neuromodulation : Journal of the... Aug 2021Subcutaneous trigeminal nerve field stimulation (sTNFS) is a neuromodulatory treatment for neuropathic trigeminal pain with the ability to reduce the intensity and...
INTRODUCTION
Subcutaneous trigeminal nerve field stimulation (sTNFS) is a neuromodulatory treatment for neuropathic trigeminal pain with the ability to reduce the intensity and frequency of pain attacks. However, hardware issues including lead migration, skin erosion, infection, so-called pocket pain at the site of the implanted neurostimulator are reported. Implantable wireless neurostimulation technology promises not only an even less invasive sTNFS treatment and thinner and more flexible electrodes better suited for facial implants, but also provides further advantages such as lack of an implantable neurostimulator and 3T magnetic resonance imaging compatibility.
MATERIAL AND METHODS
All patients who had received trial stimulation with a partially implantable sTNFS system were analyzed for ICHD-3 (3rd edition of the International Classification of Headache Disorders) diagnosis, success of trial stimulation, pre- and postoperative pain intensity, frequency of attacks, complications, and side-effects of sTNFS.
RESULTS
All patients (N = 3) responded to sTNFS (≥50% pain reduction) during the trial period. According to ICHD-3, N = 2 of the patients were classified with trigeminal neuralgia (TN) with concomitant persistent facial pain and N = 1 patient with multiple sclerosis associated TN. The time of the test period was 44 ± 31.24 days (mean ± SD). The average daily duration of stimulation per patient amounted 2.5 ± 2.2 hours (range 1-5). The pain intensity (defined on a visual analog scale) was reduced by 80% ± 17% (mean ± SD). Reduction or cessation in pain medication was observed in all patients. No surgical complications occurred in the long-term follow-up period of 18.84 ± 6 (mean ± SD) months.
CONCLUSION
The partially implantable sTNFS device seems to be safe, effective, and reliable. Compared to conventional devices, the equipment is not limited to the length of trial stimulation. Furthermore, the daily stimulation duration was much shorter compared to previous reports.
Topics: Electric Stimulation Therapy; Electrodes, Implanted; Humans; Pain, Intractable; Treatment Outcome; Trigeminal Nerve
PubMed: 34313358
DOI: 10.1111/ner.13478 -
Journal of Cardiothoracic Surgery Sep 2020Pocket-related complications following the implantation of cardiovascular implantable electronic devices primarily include pocket hematoma, infection, skin erosion or...
BACKGROUND
Pocket-related complications following the implantation of cardiovascular implantable electronic devices primarily include pocket hematoma, infection, skin erosion or decubitus, device migration, and Twiddler's syndrome, with other pathologies such as nerve impairment or bone lesions being extremely rarely encountered. We report a case of a 20-year old asthenic, non-athlete female patient presenting with a device-generated fracture of the second rib several months after sub-muscular permanent pacemaker implantation due to repeated bilateral pre-pectoral pocket infections.
CASE PRESENTATION
A 20-year old female patient was readmitted to our institution 9 months following sub-pectoral implantation of a permanent pacemaker, complaining of severe pocket-related pain, which arose spontaneously in the absence of direct trauma, intense physical activity or vigorous coughing, and was associated with normal day-to-day activity. To rule out a pacemaker re-infection, a native computed tomography and a positron emission tomography-computed tomography of the thorax were performed. Both modalities excluded an infection but showed a healing fracture and a focus of enhanced metabolic activity in the anterolateral part of the right second rib, indicating a non-traumatic or stress fracture of the bone. Consequently, a complete extraction of the pulse generator and both leads was performed and the smallest available single-chamber pulse generator with a single atrial electrode was implanted in the sub-fascial, pre-muscular pocket in the now recovered and uninfected left subclavicular region, alleviating patient's severe pain symptoms and significantly enhancing her quality of life.
CONCLUSIONS
In the absence of direct trauma, intense physical activity or vigorous coughing, we assume that in this asthenic girl a normal day-to-day motion of the right shoulder has persistently forced the sub-muscularly placed pulse generator toward thoracic wall, putting increased repetitive pressure force on the underlying bones, finally causing a fatigue stress fracture of the second rib. In asthenic phenotype patients with small thorax and short subclavicular distance, a sub-muscular pacemaker implantation can potentially cause unique and unexpected pocket-related adverse events necessitating advanced diagnostics and timely treatment.
Topics: Diagnosis, Differential; Female; Fractures, Stress; Humans; Pacemaker, Artificial; Postoperative Complications; Quality of Life; Rib Fractures; Tomography, X-Ray Computed; Young Adult
PubMed: 32938486
DOI: 10.1186/s13019-020-01303-y -
Current Drug Metabolism 2021Aim & Background: Ornidazole is an antimicrobial drug used to treat certain types of vaginal, urinary tract, and interstitial infections. The study aims to formulate and...
UNLABELLED
Aim & Background: Ornidazole is an antimicrobial drug used to treat certain types of vaginal, urinary tract, and interstitial infections. The study aims to formulate and evaluate the dental inserts by using a drug candidate to sustained drug release to improve patient compliance, reduce dosing frequency, reduce the risk of dose dumping, and avoid the first-pass metabolism. They have better therapeutic efficacy and fewer side effects.
METHODS
The dental inserts were prepared using various polymers alone and in combination with the different ratios of polymers. The evaluation parameters like thickness, drug content, content uniformity, moisture reuptake, weight variation, swelling studies, and erosion studies of the optimized inserts were studied. The in-vivo studies were conducted to determine the reduction of pocket depth in human volunteers.
RESULTS
The system containing ethylcellulose and hydroxyl methyl propyl cellulose K100M (4:1) formulation F6 was optimized because drug release was sustained up to 120 hrs concerning other formulations. Optimized formulation followed first-order kinetics and Peppas release kinetics via fickian diffusion. There was no swelling, itching, irritation, and no reduction in the pocket depth in in-vivo studies.
CONCLUSION
The study concluded that dental inserts could extend the release of Ornidazole for many hours and also enhance bioavailability. Furthermore, they also help in avoiding the first-pass effect. In vivo studies' observations showed no itching, irritation, swelling, and pocket-depth reduction.
Topics: Anti-Infective Agents; Biological Availability; Cellulose; Delayed-Action Preparations; Dental Implants; Drug Compounding; Humans; Hypromellose Derivatives; Ornidazole
PubMed: 33618642
DOI: 10.2174/1389200222666210222152940 -
Eye & Contact Lens Sep 2011To evaluate the efficacy of a novel technique of intrascleral reverse pocket approach of transconjunctival transscleral (TC-TS) sulcus fixation of intraocular lens (IOL)...
PURPOSE
To evaluate the efficacy of a novel technique of intrascleral reverse pocket approach of transconjunctival transscleral (TC-TS) sulcus fixation of intraocular lens (IOL) implants in posttraumatic eyes.
METHOD
A prospective case series of 12 patients who had ocular trauma underwent TC-TS fixation of intraocular implants (including posterior chamber IOLs, rigid or foldable and capsular tension ring) were examined for any intraoperative complications, postoperative best-corrected visual acuity (BCVA), status of conjunctiva, and other potential complications.
RESULTS
Twelve eyes of 12 patients (8 men and 4 women) with a mean follow-up of 14.5±7.25 months were included in the analysis. In no case was any intraoperative deroofing of the tunnel or buttonholing of the conjunctiva performed. The mean final BCVA (in Snellen Equivalent [SE]) showed significant improvement from preoperative levels (0.48±0.29 SE vs. 0.65±0.19 SE, respectively; P=0.049). One case showed a single line drop in the BCVA at final follow-up. Another case had a dispersed vitreous hemorrhage in the immediate postoperative period that cleared in 3 weeks' time. One eye demonstrated a clinically detectable IOL tilt, which was corrected by astigmatic prescription in the spectacle glass. None of the cases exhibited postoperative suture knot erosion or breakage of polypropylene sutures until the last follow-up.
CONCLUSIONS
The technique of intrascleral reverse pocket approach of TC-TS fixation is a successful method of sulcus fixation, which can obviate the need for conjunctival peritomy, thus helping in salvaging the conjunctiva for any future trabeculectomy in posttraumatic eyes predisposed to developing glaucoma.
Topics: Adolescent; Adult; Aged; Child; Conjunctiva; Eye Injuries; Female; Humans; Intraoperative Complications; Lens Implantation, Intraocular; Lenses, Intraocular; Male; Middle Aged; Prospective Studies; Sclera; Suture Techniques; Visual Acuity; Young Adult
PubMed: 21862898
DOI: 10.1097/ICL.0b013e318228e402 -
Pain Practice : the Official Journal of... Jul 2022Spinal cord stimulation (SCS) is effective for the treatment of chronic intractable pain of the trunk and limbs. The mechanism of action may be based, at least in part,...
Spinal cord stimulation (SCS) is effective for the treatment of chronic intractable pain of the trunk and limbs. The mechanism of action may be based, at least in part, upon the gate control theory; however, new waveforms may suggest other mechanisms. Although benefits of the SCS technology generally outweigh the complications associated with SCS, some complications such as infection and skin erosion over the implant can result in device removal. Additional reasons for device removal, such as pocket pain and battery depletion, have driven technological innovations including battery-free implants and device miniaturization. The neurostimulation system described here was specifically designed to address complications commonly associated with implantable batteries and/or larger implantable devices. The benefits of the small size are further augmented by a minimally invasive implant procedure. Usability data show that patients found this novel neurostimulation system to be easy to use and comfortable to wear. What is more, clinical data demonstrate that the use of this system provides statistically significant reduction in pain scores with responder rates (defined as ≥50% reduction in pain) of 78% in the low back and 83% in the leg(s). Advances in miniaturization technology arose from the considerable shrinkage of the integrated circuit, with an increase in performance, according to Moore's law (1965). However, commensurate improvements in battery technology have not maintained a similar pace. This has prompted some manufacturers to place the battery outside, against the skin, thereby allowing a massive reduction in the implant volume, with the hopes of fewer device-related complications.
Topics: Chronic Pain; Humans; Pain Management; Spinal Cord; Spinal Cord Stimulation; Treatment Outcome
PubMed: 35509116
DOI: 10.1111/papr.13124 -
Veterinary Ophthalmology Mar 2020To evaluate the results obtained using Morgan pocket technique and chondrectomy (MPTC) alone, or combined with a wedge conjunctivectomy (MPTC + WC) for the treatment...
Treatment of prolapsed gland and cartilage deformity of the nictitating membrane with pocket technique and chondrectomy alone, or combined with a wedge conjunctivectomy: 132 dogs (1998-2018).
OBJECTIVE
To evaluate the results obtained using Morgan pocket technique and chondrectomy (MPTC) alone, or combined with a wedge conjunctivectomy (MPTC + WC) for the treatment of prolapsed gland associated with cartilage deformity of the nictitating membrane (PGCD) in dogs.
PROCEDURE
Medical records of dogs diagnosed with PGCD that received a MPTC or MPTC + WC were reviewed between 1998 and 2018. Success rate was defined by lack of recurrence of the prolapsed gland with a minimum of 6 months follow-up. Histological examination of the excised cartilage was performed in 13 eyes.
RESULTS
A total of 132 dogs (181 eyes) met the inclusion criteria. Median follow-up time was 25 months (range, 6-166 months). MPTC was used in 131 eyes with 91.6% success rate. MPTC + WC was used in 50 eyes with 100% success rate. Postoperative complications occurred in 6.9% and 4%, respectively, for MPTC and MPTC + WC, including lacrimal cysts (8 eyes) or corneal erosion (3 eyes). Recurrence and complications rates were significantly lower using MPTC + WC compared with MPTC in the giant breed dogs (P = .019 and P = .002, respectively), but not in the overall study population (P = .328 and P = .290, respectively). Histological cartilage anomalies were noted in 2/13 specimens from chronic PGCD.
CONCLUSIONS
MPTC + WC offers a good therapeutic option for giant breed dogs with PGCD. The combined technique provides a good apposition and mobility of the nictitating membrane onto the ocular surface and potentially reduces the risk of recurrence in these giant canine breeds.
Topics: Animals; Cartilage; Dog Diseases; Dogs; Eyelid Diseases; Female; Male; Nictitating Membrane; Ophthalmologic Surgical Procedures; Prolapse; Treatment Outcome
PubMed: 31746106
DOI: 10.1111/vop.12727